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Anatomy of larynx

larynx
• A cartilaginous structure present in front of
C3-C6
• About 5cm in long in adults
• Shorter and higher in women and children
• Moves on deglutition(*)
• Primary function is sphincteric in nature
• Organ of phonation
• The typical male voice develops only at
puberty
Skeleton of larynx
• Thyroid cartilage,cricoid
cartilage and epiglottis
(unpaired cartilages)
•Arytenoids,corniculates and
cuneiforms(paired)
Thyroid cartilage

Front view Side view


Thyroid angle
(laryngeal prominence)

• 900 in males

• 1200 in females
Cricoid cartilage

Posterior view Side view


epiglottis
Membranes and ligaments
arytenoids
False vocal cords
(vestibular folds)
• Lower borders of
quadrangular
membrane(vestibular
ligament) F F
• Present above and
lateral to the true
vocal cords
• Pinkish in appearance
• (vascular)
True vocal cords
• Upper borders of
conus elasticus
• Involved in phonation
• Pearly white in
appearance
• Present below and
medial to false vocal
cords
Conus elasticus
• Crico-thyro-arytenoid
ligament
• Its free upper border
is the fibrous ligament
of the true vocal cord
Cavity of larynx
• Divided into 3 parts
by these vocal cords
• 1.vestibule
• 2.sinus (ventricle)
• 3.infraglottic cavity
Rima glottidis(glottis)
• Space between the
two vocal cords(true
vocal cords)
• Directly concerned
with voice production
• Rima vestibuli is the
space between the
false vocal cords
Saccule of larynx
• Extension from sinus
• Secretes mucus to
keep the vocal cords
lubricated.
Intrinsic muscles
• These help in
• opening and closing the glottis ,
• altering the length and tension of the
vocal cords and
• closing the inlet.
• All are supplied by recurrent laryngeal
nerve except cricothyroid(supplied by
external laryngeal nerve)
Inlet of larynx
A
• Opens superiorly into
laryngopharynx
• Oblique
• leads to vestibule of
larynx

P
Muscles of inlet
• oblique arytenoids,
transverse arytenoid
and aryepiglottic
muscles
• close the inlet during
swallowing
Bending of epiglottis
(during deglutition)
Tensor of the vocal cord
• Cricothyroid muscle is the
“tensor of the vocal cord”
• The only intrinsic muscle
placed externally
• Tilts “the thyroid cartilage
forwards” and the
arytenoids backwards”
• so that vocal cords
become longer
Cricothyroid in action
Muscles of the vocal cords
• Posterior crico
arytenoid(5 in the pic)
is
• The ONLY
ABDUCTOR of the
vocal cords and
keeps the airway
open
• (life saving muscle!!)
The abductor in action

Superior view
Muscles closing the glottis
(adductors)

Lateral cricoarytenoid muscles


Relaxers of the vocal cords

Main relaxers are


Thyro arytenoid muscles
A part of this muscle is called
“vocalis”
Movements of vocal cords

During speech(adducted)

During breathing(abducted)
stemband[1].avi
Apex should be anterior

Office view

Operating view
Blood supply and nerve supply
of larynx
• true Vocal cords are reference points
• Up to the cords supplied by superior
laryngeal artery(br.of superior thyroid)
• Below the cords supplied by inferior
laryngeal artery
•Up to the cords sensory nerve is
• internal laryngeal nerve(of X) (1in fig)
•Below the cords, sensory nerve is
• the Recurrent laryngeal nerve(of X)(3in fig)

1
2

3
laryngoscopy
A

P
Vocal cord paralysis

Injury to recurrent laryngeal nerve causes paralysis of the


ipsilateral cord(same side)
Usually the left rec.laryngeal.nerve is affected(?)
So the left cord is paralyzed
SEMON’S LAW

• In recurrent laryngeal nerve injury the


abductor is the first to paralyze and last to
recover.
summary

cu
cor
Mucosa removed
From behind(mucosa intact)
Trachea
Trachea
• Wide,fibrocartilaginous
tube beginning at C6
• Lies anterior to
esophagus and in the
superior mediastinum
inclines to the right side.
• and ends by dividing
into right and left
principal bronchi at the
level of sternal angle.
Tracheal rings(15-20)

carina
The carina is the upwardly directed ridge
seen internally at the bifurcation
and is a landmark during bronchoscopy
relations
Right bronchus is directly in line with trachea
Bronchial tree
Applied anatomy
• tracheostomy
• Tracheo bronchial lymph nodes and
carina
• (lung’s lymphatic drainage)
1.Can you see the tracheal shadow and principal bronchi?

2.Male or female?
http://anatomy.med.umich.edu/surface/cardinal/cardinal.html

Check for all surface anatomy and eye movements